NURSING HOME REOPENING RECOMMENDATIONS FOR STATE & LOCAL OFFICIALS | CMS
STATE HEALTH OFFICER’S STATEWIDE ORDER
Below you will find the link to the State Health Officer’s Statewide Order under the Safer at Home Order which is effective April 30, 2020 @ 5pm.
Item 11 in the Order specifically includes assisted living facilities, specialty care assisted living facilities along with nursing homes and hospitals. The Safer at Home Order will NOT change the restrictions these healthcare facilities are currently operating under. Facilities should continue to operate as they are now.
If you have any questions, please email AssistedLiving@alaaweb.org
To view the State Health Officer’s Statewide Order click here:
**Extended “Safer at Home” Health Order**
SAMPLE VISITATION GUIDELINES
1. The community’s administrator or designee will be responsible to establish requirements of visitors including establishing in advance expectations of the activities to be provided by the visitor.
2. Communities may determine the maximum number of visitors permitted in the facility at one time. Communities should carefully assess the risks of permitting a visitor and re-evaluate these as conditions change within the setting and the broader geographic area.
3. Facilities may consider scheduling of visitation. This should be clearly established in advance and appropriate to the community’s needs to manage visitors.
4. Communities should carefully consider the current status of COVID-19 both in their building and local geographic area prior to allowing visitors. The community may temporarily suspend visitation if deemed necessary by the administrator or designee as established by the community’s program guidelines or state or federal guidelines.
5. If residents are cohorted by COVID-19 status, visitors will not be allowed in areas designated to care for COVID-19 individuals or areas designated to care for persons with unknown COVID-19 status.
6. Risk should be minimized by establishing clear plans for PPE use, including the type of PPE required, who is responsible for providing PPE, if the facility will furnish PPE to visitors (and if at any cost), instruction on proper use of PPE, COVID-19 screening, entry and exit procedures, locations where visitors may be present with tightly restricted movement through the facility, appropriate uses of indoor/outdoor spaces, and distancing policies with others in the community.
7. Communities may establish screening procedures for symptoms of COVID-19 before entering the setting, to include an elevated temperature, and may require a negative COVID-19 test prior to scheduling visits and any regular testing as deemed necessary. Visitors should be instructed to closely monitor their symptoms and not visit if experiencing any symptoms.
8. Communities should closely track the arrival and departure of visitors, to include names, addresses, email addresses, and time in/out for purposes of contact-tracing as required by state or federal guidelines or regulations.
9. Visitors should be provided with guidelines on the expectations of their role, to include making safe choices about personal contacts and activities outside of the home.
10. Communications between the visitor and facility will be through any relevant forms of communication used by the community.
11. Any additional requirements within specialty care assisted living facilities must be clearly established and communicated to all visitors, staff, and any others present within these areas.
12. The facility may temporarily suspend or terminate visitor status for failure to comply with their agreement or the community’s guidelines.
13. All facility staff should be made aware of the policies and guidelines for visitors and how they will be implemented and enforced.
In addition, each facility subject to this paragraph shall post in a conspicuous location at each public entrance a statement substantially similar to the following statement:
By order of the Governor of Alabama and the State Health Officer, each patient or resident of this facility enjoys certain rights to have one caregiver or one visitor present at a time, subject to reasonable restrictions. If you have questions, you may ask to inspect the facility’s written policies concerning visitation.
CMS guidelines as of 4/2/2020-
To view the HealthCare Worker Liability Protection Proclamation from the Governor, click here.
A reminder from Dennis Blair, ADPH-
I want to remind everyone that facilities are responsible for reporting suspected COVID-19 to their local Health Department. If a facility is suspicious enough to test, they need to report. Health Provider Standards would also appreciate a courtesy notification as well, email@example.com or Mia.Sadler@adph.state.al.us
In regards to admitting residents, the facility would not be in violation of State Board of Health (SBOH) rules if it chose not to admit residents at this time. However, if a facility chooses to admit a resident, the resident must meet all admission criteria found in the rules including a statement from the physician that the resident is free from contagious or infectious disease. A problem I see with admitting a new resident is the coming and going of the resident’s family while moving the resident into the facility. These “visitors” would violate the state mandatory health order and the CDC guidelines that only essential healthcare personnel can visit the facility.
Regarding the coming and going of staff, the facility is responsible for screening employees for signs and symptoms of infection at the beginning of the employee’s shift. I have included the link to the CDC website that provides recommendations for screening and assessing staff.
ALFs and SCALFs are long term care facilities and should be following the guidelines and recommendations set forth by the ADPH and the CDC for protecting residents and staff from infection and spread of COVID-19. I have included links to those websites. In addition, you will also find a link to the state wide mandatory health orders issued by Dr. Harris, State Health Officer. Please be sure to review those orders.
How does it work when we have a resident in the hospital or at rehab and they are ready for discharge? We have one who is in rehab now and they are wanting to discharge her.
Residents should be thoroughly assessed for eligibility to return to the facility. The facility should ensure the resident has been cleared by the physician to be free of signs and symptoms of contagious and/or infectious disease. The facility should conduct its own screening for signs and symptoms of infection upon re-entry into the building and continue diligent health observation of the resident.
What is appropriate dining in an Assisted Living. If a resident(s) prefer to dine in the communal dining area, their request is documented to include their understanding of the risks involved, this action is care planned, social distancing is maintained, would this be allowed?
The facility is responsible for following guidelines put in place by the ADPH and the CDC. If the dining room can be arranged to meet the required social distancing and the number of residents gathering, I don’t see a problem. Currently social distancing is 4-6 feet from one person to another, that would mean not sitting side by side at a table with other residents, and less than 25 people gathered in the same area. Keep in mind these numbers can and probably will change, I know the President was talking about a gathering of 10 or less people.
I understand these are difficult times for staff and residents but it is the facility’s responsibility to do what they need to do to protect residents from infection.
EMPLOYER INSIGHTS INTO THE FAMILIES FIRST CORONAVIRUS RESPONSE ACT (“FFCRA”)
On March 18, 2020 President Trump signed the Families First Coronavirus Response Act (“FFCRA”) to provide relief to employees from economic issues stemming from the COVID-19 pandemic. In our effort to keep ALAA members informed, we would suggest that you visit LYONS HR at: WWW.LYONSHR.COM. LYONS HR is an Associate Member of ALAA and we consider LYONS HR a subject matter expert when it comes to employment matters, human resources management, and workplace regulatory compliance assistance. For those of you who do not have a full-service HR departments, and need help in navigating the many concerns relating to COVID-19, you may contact Alan Ridgway and he will be available to offer assistance and guidance as needed to address your concerns. You can reach Alan at:
Sr. Vice President
Office: (256) 546-9493 Ext. #601
Cell: (205) 914-8412
Alabama, and disparities and shortages in testing availability in areas of the state. The CDC indicates in the full guidance that the option for ending Quarantine after 7 days, should only be considered “when diagnostic testing resources are sufficient and available.” CDC further indicates that “Testing for the purpose of earlier discontinuation of quarantine should be considered only if it will have no impact on community diagnostic testing. Testing of persons seeking evaluation for infection must be prioritized.”
Persons in long-term care facilities and other congregate living settings will continue to be quarantined for 14 days without testing per existing recommendations to focus on maximally reducing the risk of transmission. The 14-day quarantine period remains the preferred option by the CDC and ADPH.
Healthcare Personnel (HCP), the guidance has not changed, so please continue to refer to this guidance: https://www.
alabamapublichealth.gov/ covid19/assets/cov-timeframes- isolation-quarantine-hcp.pdf
The updated ADPH COVID-19 Quarantine and Isolation Timeframes can be reviewed at https://www.
alabamapublichealth.gov/ covid19/assets/cov-timeframes- isolation-quarantine.pdf
CORONAVIRUS LTC UPDATE March 16, 2020
ADPH is no longer requiring patients meet a certain criteria in order to be tested for COVID-19. Any person that a physician determines qualifies for coronavirus testing should be tested. The ADPH is recommending that https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html those at the highest risk be tested.
We know that senior citizens and those with chronic health problems (a perfect description of our residents) are more susceptible to contract this virus and more likely to die from complications of this virus. The task to prevent this from occurring is monumental. The Association realizes that the guidelines posted are significant and may seem extreme. We must remember that we are facing a disease that leaves the health care industry and public health care authorities with more questions than answers at this time. The authorities are working diligently to quell the spread of this disease and some of the recommendations published may seem like a hardship, but the severity of the hardship can’t be measured until the crisis passes, when there is an opportunity to review the effectiveness of those recommendations.
The ALAA is encouraging you to stay strong, reach out to others for ideas and support, and follow the guidelines and recommendations available to you. Just as a reminder, last week the ADPH ALF/SCALF regulatory unit announced that it will be using CMS guidelines and recommendations as its authoritative resource in dealing with the coronavirus. What does that mean to our facilities? For purposes of compliance (and facility liability) your facility is expected to be operating within guidelines and recommendations set out by CMS during this emergency.
Below is a link to the most recent CMS guidance for infection control and prevention of coronavirus in LTC facilities. Included in that guidance you will find information on the compliance aspect resident’s rights related to restriction of visitation, when to send a resident to the hospital, supply resources and other helpful guidance for your facility. Please review some of the links in the document for applicability to your facility.
The ALAA will send out updates as we receive them.
COVID-19 posting 3-14-2020
As the Coronavirus continues to spread the Centers for Medicare & Medicaid (CMS) has announced new guidelines to protect seniors in long-term care facilities. The new guidelines call for restriction of visitors and non-essential staff or other health care personnel into facilities. The ALAA is aware of many ALFs and SCALFs throughout the Alabama that have already implemented some type of visitor restriction. We encourage all providers of assisted living services in Alabama to follow the guidance of CMS during this state of emergency.
The CMS guidelines include:
** Restricting all visitors, effective immediately, with exceptions for compassionate care, such as end-of-life situations; (In these cases, visitors will be equipped with personal protective equipment (PPE) like masks, and the visit will be limited to a specific room only.)
** Restricting all volunteers and nonessential health care personnel and other personnel (example: beauticians);
** Cancelling all group activities and communal dining; and
** Implementing active screening of residents and health care personnel for fever and respiratory symptoms.
The ALAA advises all assisted living facility staff be screened prior to resident contact each day. Anyone entering the facility, such as home health or hospice staff, should also be screened for fever and respiratory symptoms before being allowed into the facility and should sign in and out.
The link to the most recent CMS guidelines is: https://www.cms.gov/newsroom/press-releases/cms-announces-new-measures-protect-nursing-home-residents-covid-19
The ALAA will continue to update its membership as situations change.